Financial Statement (Page 4 of 7) in pdf

Financial Statement Page 4

H. OTHER ASSETS. List all other property, having a value in excess of $100 for each item, which has not been listed in any other

category above. Give your best estimate of current market value. Examples: any right to sue, lump sum settlement of personal

injury, workers compensation, patents, income tax payments or deductions for current year, anticipated income tax refunds, etc. Do

not deduct debts secured by any item. If there is a debt, check in the debt column and list the debt in Section I, Debts, below. If you

need more space, check here ❐ and add attachments as necessary.

Item

Date Acquired

Current Value

Debt

Non-

marital

DEBTS. List all personal and business debts, credit card accounts, unpaid medical expenses, and other debts. If the debt is

secured by a mortgage, lien, or other security interest on property listed in this Part, write in the “Security” column the section and

item number where the properly is listed in this Part, e.g., A1, B1, etc. . If you need more space, check here ❐ and add attachments as

necessary.

Name and Address of Creditor

Date Incurred

Name of Person(s)

Account Now Owed

Security

Non-

Liable

marital

Pursuant to M.R.Civ.P. 108(d)(3), the information on this form is not subject to public inspection.

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Financial Statement Page 4